Questions COPY Flashcards
Why did you become a doctor?
There were many things that led me to choose medicine, but I think a few key factors stand out…
I was 16 years old, living in India
- Diverse backgrounds - from race, social class and religion
- Growing up abroad - education and healthcare community
- Needed a practical job - direct impact of my work on people and community.
What is your plan if you are unsuccessful in securing this post?
Ask for feedback and review this with my supervisor.
Make a plan and timeline for how to enhance and grow from this experience - including clinical skills, research, teaching and presentations.
How important is teaching to you and how does this relate to this role?
Teaching and education is pivotal to this position and Gynae-oncology in general. There are two sides to this -
Teaching I can provide - day to day on the shop floor, Mentorship,
(helps to solidify your knowledge by being to explain it on a basic level)
I like to regular teaching sessions, anatomy with juniors
Teaching - public health. Patients.
clinic
red flags
Below the belt
Share ideas on regional, national and international level - presentations and conferences - all stay up to date in the Gynae Onc community and transfer our wealth of knowledge.
Teaching can receive - Up to date, international and national conferences. BGCS webinars, Grand round, mentorship and constructive feedback. OSATs
How important are research and development opportunities to you and how does this relate to this role?
Research and development is intrinsic to Gynae Oncology. It moves at a pace and it is important to always be up to date and moving the practice of the department along with it.
Exciting!
New ways of doing things - new equipment, new pathways. increasing efficiency.
identifying issues. Collaborating - getting ideas from our colleagues - both in the unit and discussing with surrounding units.
Critical analysis - heightens your understanding of
Being a part of research projects enhances your understanding of critically appraising other research.
Doing the cochrane review has given me the tools to do this and I would like to use these to help others
National trials. Excites patients and staff - boosts morale
Gain more experience in PI or running a multicentre trial.
What other specific challenges do you expect to experience in this role?
TIME - organised
plan: other specialities, courses, discuss with SST for tips
MEETINGS - SMART objectives, holding myself accountable
TECHNICAL and NON TECHNICAL
acquiring the skills and maturity required for complex decision making - MDT, intra-operatively,
Paperwork
How good a doctor are you?
I’d like to think that I show many of the qualities described by the GMC denoting a ‘good doctor’ but specifically I’d like to think that people say I am :
- Teamwork
- Teaching, staying up to date, research
- Communicating - advanced comms course
- Staying up to date
Management research and teaching - Holistic care
- MDT for best possible care
- Documentation
- Quality assurance and quality improvement
- Raise risks to patient safety and make steps to rectify
- Communication with patients
- Work collaboratively with colleague
- Teaching and training juniors
- Continuity and coordination of care
- Partnership with patients
- No discrimination
- Honesty and integrity – clinical and research
Best example of working as a proactive team member to achieve something
Sentinel node - coordinating the rep
What is your best example of having a positive impact on your team’s morale
team morale is sustained behaviour
inspiration from my bosses - ensuring I know the name of people, what they do and helping them do their job when
what is your best example of contributing to the improvement of a team’s efficiency
anaemia -
group and saves prior to the day
recognising and creating a pathway
Weaknesses
attention to detail
control
delegation
support
pressure on myself, passion frustration,
mentor - reassure and constructively criticise
Tell me about your surgical skill
40+ staging laparotomies for pelvic masses
40+ laparoscopic hysterectomies, with or without sentinel lymph node sampling
15 vulval excision
6 laparoscopic pelvic lymphadenectomy
3 radical vulval
7 cytoreductive
Strengths
There are some key strengths I think are important to being a Gynae-Oncologist. One of these is
enthusiastic, dedicated
organised, conscientious
caring holistic
Why do you want to do Gynae Oncology?
I love operating and first and foremost Gynae-Oncologists are surgeons.
I love working as a part of a team! We have such a wide
I love the immense pleasure that comes from managing patients who are going through what is one of their worst experiences in their life and
Tell me about your research
- MD
- Associate PI for UHS for ROCkeTS trial
- Cochrane
- Dedication and how to critically analyse papers, assess the risk of bias and synthesize them in to a meta-analysis answering a specific clinical question
If you thought you needed an ultrasound machine for the unit, how would you go about it?
Speak to colleagues, service manager. Ultimately "cash-strapped" environment pre-existing alternative solutions? If not - build a business case benefits to patients, staff and organisation improve outcomes, indicate the demand value for money
Do you think that all exenterations should be centralised
2 sides to the argument
1. Centralisation to create centre for clinical excellence
- Retain the procedures in regional tertiary units.
Benefits: care as local as possible to patients - in keeping with the NHS long term plan
How you ensure the patients receive gold standard care is through close collaboration with colleagues from colorectal, urological and plastic specialities, as well as the wide allied health care professionals required to support the peri and post operative period.
Time and planning to organise joint procedures
LACC trial
2018
MIS vs open
Mostly IB1
3 year disease free survival 91 vs 97%
4.5 year DFS 87% vs 97%
Robotics 15% laparoscopic 85%
Tell me about your teaching experience
Diverse experience of teaching.
- One which might seem unusual is that, alongside a beauty therapist, I have set up a virtual educational programme for beauty therapists for recognition of red flag symptoms for gynaecologial and breast cancers, as well as vulval lesions. More confident to signpost towards medical care.
Under the supervision of SK - run RTD for KSS in Principles of - More conventionally - teaching on the shop floor in wards, clinics, theatres, departmental teaching to medical students, nurses, F1s , SHOs and registrars.
- I am also pleased to have had more formal teaching and examination experience - having 4 years of OSCE which has taught me more needs and level required.
Also lecturing the undergrad pharmacology students
Will the NHS survive this winter
Another enormous challenge ahead of us
We have done it before
Not an endless pot
prioritisation of healthcare on a level never previously imaginable
LTP - enhancing social care
Relationship with the IS has changed
Should we centralise the treatment of cervical cancer
Varied by stage.
- Stage 1 cancers - LLETZ/simple hysterectomy, closer to home
- Advanced cervix cancer, chemo rad, close to home.
Leaves a debate as to whether the treatment of IB1 and IB2 Cx cancers should be centralised.
Some would say yes, - centre of excellence
Others, and my view point:
That this is not currently necessary and that they should be treated at regional tertiary centres.
Benefit to patient: in keeping with NHS LTP, close to home
Benefit to surgeon: techniques used to perform a radical hysterectomy are natural to a gynae oncologist and transferrable to other radical procedures. We do not want to risk deskilling our gynae-oncologists.
One way to ensure continued exposure is to have joint consultant operating on these cases.
More contentious - whether exenteration for recurrent cervical cancer should be centralised
Mistake
COVID pandemic, like many moved to IS
elderly lady, TLH for endometrial cancer
As I was used to our standardised procedure Ax Duty of candour incident form reviewed with IS leads Presented at MDM Created proforma for IS
DESKTOP
DESKTOP OVAR - which patients with recurrent ovarian cancer to operate on and which not to
Q1. what should the surgical goal be
2. Who should be operated on.
Ans: complete cytoreduction.
How can we predict a complete cytoreduction
AGO score (PS0, ascites less than 500mls and previous complete cytoreduction).
Plus: platinum sensitive disease, first recurrence
Validated by DESKTOP 2 as a 75% success rate for AGO score
DESKTOP 3 - RCT
- same AGO score success for cytoreduction
- OS: 60m for CCR, 45 months for just chemo, 30m for ICCR
confirming - patient selection and centre for expertise in achieving high rate of cytoreduction.
Alternatives to DESKTOP?
GOG-0213 showed no benefit but patients were randomised and chosen to be ‘resectable’ by investigator - with lower rate of CCR of 67%
Tell us about your CV
Lucky
Clinical
Research
Teaching
Why do you want to do this job
I love operating.
technical aspect of learning the huge variation of skills required
collaborative operating with so many different specialities
intellectual intra-operative challenge - considering morbidity vs potential benefit.
TEAM - Mentioned cross speciality Team can have a narrow or broad definition in GO Core gynae onc team - strong hospital regionally - strong BGCS
Personal level
- immense privilege to manage patients at a time of crisis in their lives.
Going through difficult time in their lives - support them and their families through, best of my ability is incredibly rewarding.
Why should we choose you for this job
I’m lucky… 6 years O&G, almost 2 with GO in Brighton - giving me the solid foundation in tertiary level gynae-oncology that I needed to now accelerate in to SST.
Honed my clinical skills, meaning that I am…
I have been involved with different types of research and teaching and I know that units in KSS have a focus on these areas with some fantastic opportunities
Tell us about a time .. probity issue.
check everyone involved is safe
communicate
escalate
Cancer alliance principles
- Diagnosing cancer faster - Rapid diagnostic services
- Ensuring the best treatment and care - Dx, RXT, genomics, waiting times
- Involving patients and the public
- Personalised care - holistic needs and follow up plans
- Preventing and diagnosing cancer earlier - increasing uptake of screening
What are the challenges facing gynae oncology
worse stage specific outcomes
delays to presentation and diagnosis
increasing obesity and ovarian cancer
reducing uptake to screening
Delays to presentation
- public heath awareness campaign. - risk factors, red flag symptoms
literacy rate, changing this to video forms
Staffing, staff retention.
- names, roles and helping, encouraging ideas and empowering to help with changing interventions.
How do you deal with stress
organised, lists, staying up to date, making sure I feel on top of things.
Supervisors - pressure of learning, constructive feedback on performance and areas to improve
Seeing my sister, taking time out, cycling, walking, supportive husband
Tell us about a difficult scenario you have been involved with and how you dealt with it
storm derrick
Uterine rupture - gynae onc
Tell us how you would deal with .. probity issue.
check everyone involved is safe
communicate
escalate
Why do you want to do SST and not be a gynae onc unit lead
Huge respect for unit leads, different job
surgical challenge, when to when not to, how to safely get them through and when to involve other specialities.
heart of their treatment and follow up
Communication - most vulnerable times, using those skills to support patients and their relatives.
Cancer alliance principles
- Diagnosing cancer faster - Rapid diagnostic services
- Ensuring the best treatment and care - Dx, RXT, genomics, waiting times
- Involving patients and the public
- Personalised care - holistic needs and follow up plans
- Preventing and diagnosing cancer earlier - increasing uptake of screening
Bring centres togethre to make
uniform practice
optimise pathways
Diagnostics - regional diagnostic hubs
Support organisations struggling with their patient load
Explain an RCT
Phase 1 trials - looking for safety
(side effects, best dose and timing, ?route)
Phase II trials - side effects, how well does it work
Phase III - compares new to standard of care
looking for rare complications/toxicities needing larger numbers
steps: What team? Design the study - question, inclusion/exclusion criteria, numbers required. intervention vs control recruitment strategy - randomisation blinding Ethical considerations what are the outcomes I want to measure collecting the data statistical analysis reporting of results.
International Cancer Benchmarking Partnership
International multidisciplinary collaboration founded to facilitate mutual learning about factors that may help to improve outcomes for cancer
Characteristics relating to countries with higher stage-specific survival included higher reported rates of:
primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.
International Cancer Benchmarking Partnership
Characteristics relating to countries with higher stage-specific survival included higher reported rates of:
primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.
NHS long term plan
improving social care
integrate primary and secondary care
health promotion and targeting health inequalities
cancer - 3/4 early stage 1/2
train and retain staff
Digitalisation
Waiting time targets
14 days - referral until seen by specialist
28 days - referral until told whether has cancer or not
31 days - decision to treat to first treatment commenced
62 days - referral until first treatment commenced
cancer target performance and quality indicators